{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T02:05:05Z","timestamp":1772762705970,"version":"3.50.1"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>Acute ischemic stroke patients with history of prior ischemic stroke plus concomitant diabetes mellitus (DM) were excluded from the ECASS III trial (European Cooperative Acute Stroke Study) because of safety concerns. However, there are few data on use of intravenous tissue-type plasminogen activator and symptomatic intracerebral hemorrhage or outcomes in this population.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>Using data from the Get With The Guidelines\u2013Stroke Registry between February 2009 and September 2017 (n=1619 hospitals), we examined characteristics and outcomes among patients with acute ischemic stroke treated with tissue-type plasminogen activator within the 3- to 4.5-hour window who had a history of stroke plus diabetes mellitus (HxS+DM) (n=2129) versus those without either history (n=16\u2009690).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>\n              Compared with patients without either history, those with both prior stroke and DM treated with tissue-type plasminogen activator after an acute ischemic stroke had a higher prevalence of cardiovascular risk factors in addition to history of stroke, DM, and more severe stroke (National Institutes of Health Stroke Scale: median, 8 [interquartile range, 5\u201315] versus 7 [4\u201313]). The unadjusted rates of symptomatic intracerebral hemorrhage and in-hospital mortality were 4.3% (HxS+DM) versus 3.8% (without either history;\n              <jats:italic>P<\/jats:italic>\n              =0.31) and 6.2% versus 5.5% (\n              <jats:italic>P<\/jats:italic>\n              =0.20), respectively. These differences were not statistically significant after risk adjustment (symptomatic intracerebral hemorrhage: adjusted odds ratio, 0.79 [95% CI, 0.51\u20131.21];\n              <jats:italic>P<\/jats:italic>\n              =0.28; in-hospital mortality: odds ratio, 0.77 [95% CI, 0.52\u20131.14];\n              <jats:italic>P<\/jats:italic>\n              =0.19). Unadjusted rate of functional independence (modified Rankin Scale score, 0\u20132) at discharge was lower in those with HxS+DM (30.9% HxS+DM versus 44.8% without either history;\n              <jats:italic>P<\/jats:italic>\n              \u22640.0001), and this difference persisted after adjusting for baseline clinical factors (adjusted odds ratio, 0.76 [95% CI, 0.59\u20130.99];\n              <jats:italic>P<\/jats:italic>\n              =0.04).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Among patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator within the 3- to 4.5-hour window, HxS+DM was not associated with statistically significant increased symptomatic intracerebral hemorrhage or mortality risk.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.118.024172","type":"journal-article","created":{"date-parts":[[2019,4,30]],"date-time":"2019-04-30T09:09:30Z","timestamp":1556615370000},"page":"1497-1503","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients With History of Stroke Plus Diabetes Mellitus"],"prefix":"10.1161","volume":"50","author":[{"given":"Matthew E.","family":"Ehrlich","sequence":"first","affiliation":[{"name":"From the Department of Neurology (M.E.E.), Duke University School of Medicine, Durham, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Liang","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (L.L., H.X., A.S.K., A.F.H., E.D.P., Y.X.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haolin","family":"Xu","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (L.L., H.X., A.S.K., A.F.H., E.D.P., Y.X.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrzej S.","family":"Kosinski","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics (A.S.K.), Duke University School of Medicine, Durham, NC"},{"name":"Duke Clinical Research Institute, Durham, NC (L.L., H.X., A.S.K., A.F.H., E.D.P., Y.X.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian F.","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (L.L., H.X., A.S.K., A.F.H., E.D.P., Y.X.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee H.","family":"Schwamm","sequence":"additional","affiliation":[{"name":"Department of Neurology, Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital (L.H.S.), Harvard Medical School, Boston"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric E.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Cumming School of Medicine, University of Calgary, Canada (E.E.S.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Ronald Reagan University of California, Los Angeles Medical Center (G.C.F.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepak L.","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital Heart and Vascular Center (D.L.B.), Harvard Medical School, Boston"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric D.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Medicine (E.D.P.), Duke University School of Medicine, Durham, NC"},{"name":"Duke Clinical Research Institute, Durham, NC (L.L., H.X., A.S.K., A.F.H., E.D.P., Y.X.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Xian","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (L.L., H.X., A.S.K., A.F.H., E.D.P., Y.X.)"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199512143332401"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0804656"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000158"},{"key":"e_1_3_3_5_2","unstructured":"The European Agency for the Evaluation of Medicinal Products. 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